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The Era of Delivery System Reform Begins

Zirui Song, PhD; Thomas H. Lee, MD
JAMA. 2013;309(1):35-36. doi:10.1001/jama.2012.96870.
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Health care reform evolves in distinct phases. Insurance reform, the critical first step, gained a foothold through the 2010 Affordable Care Act. The nation now enters the midst of payment reform, a second chapter motivated by the need to slow health care spending. Payers across the country are increasingly putting health care on a budget, moving from fee-for-service to lump-sum payments for bundles of services or populations of patients.

Hospitals, health care centers, and physicians in turn are consolidating into accountable care organizations (ACOs) to address these new payment contracts, which reward lower spending and higher quality. In July, 89 new ACOs were launched in Medicare. Combined with 59 Medicare ACOs started in January, these organizations bring more than 130 000 physicians and 2.2 million beneficiaries into an emerging model of organization-based health care.1 Global budget contracts from private insurers are doing the same for millions more working-age adults, their families, and their physicians.2

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Figure. Organizational Attributes of ACOs in the Medicare Shared Savings Program
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Organizational attributes for the 89 Shared Savings Program (SSP) accountable care organizations (ACOs) launched in July 2012 are collected as reported by the Centers for Medicare & Medicaid Services; those for the 27 SSP ACOs launched in January 2012 are as gathered by the authors. Organizations with multiple attributes are counted multiple times. On average, SSP ACOs had about 1.5 attributes each.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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